Fatty liver:

Fatty change:
Metabolism of alcohol produces fat in the
liver (zone 3).
Effect minimal with small amounts but
steatosis (cells swollen with fat) occurs with
large amounts.
Gives swiss cheese effect on haematoxylin
and eosin stain.
Also seen in:
Obesity
Diabetes
There is no permanent cell damage and fat
disappears on stopping alcohol
Alcoholic hepatitis:

Often assymptomatic
May have vague abdominal symptoms:
Nausea
Vomiting
Diarrhoea
These are more likey due to GI effects of
alcohol
Hepatomegaly may be present as may other
signs of chronic liver disease
Alcoholic hepatitis:
Varibiable:
mild symptoms with hepatitis only being
apparent on biopsy

Clinical features

In addition to fatty change there is

leucocyte infiltration and hepatocyte
necrosis (zone 3)
If consumption is maintained then cirrhosis
may develop

Mild-moderate symptoms e.g mild jaundice,

pruritis, fatigue. Dx is made on liver
histology.
Severe cases the patient is ill with jaundice,
ascites, abdominal pain, & a high fever
associated with liver necrosis. O/E
hepatomegaly, jaundice, splenomegaly,
ascites, ankle oedema

Pathology

Alcoholic cirrhosis:

Alcoholic cirrhosis:

Classically micronodular cirrhosis

acompanied by fatty change and evidence
of pre-existing alcoholic hepatitis

Represents final stage of liver disease.

O/E hepatomegaly, jaundice, splenomegaly,
ascites, ankle oedema

Alcoholic liver disease

Fatty Liver:

Stop drinking
Chlordiazepoxide 'detox regime'. (for
withdrawl)
IV thiamine {pabrinex 1+2} (prevent
wernicke-korsakoff)
Vitamin & protein suplements (contained in
pabrinex)
Support
Consider anti-depressants
Consider disulfiram (unpleasant symptoms
if alcohol consumed)

I if patient abstains from alcohol then fat

will disappear and LFTs return to normal.

Alcoholic hepatitis:
Prognosis is variale.
Despite abstinence disease may be
progressive.
50% mortality in severe cases.
If PT > 2x normal, encephalopathy, & renal
failure then 90% mortality.

General:

Prognosis

Fatty liver:
Management

Alcoholic cirrhosis:

Advise to stop drinking

Alcoholic hepatitis:

90% survival at 5 years with abstinence

60% with continued drinking
If jaundice, ascites, haematemesis then 35%
survival

Advise to stop drinking

Tx encephalopathy & ascites
NG tube for feeding
Vit B&C IM
Corticosteroids (only if no infection present)

Alcoholic cirrhosis:

www.mqlearn.co.uk

There is no treatment available to reverse

cirrhosis.
Management is aimed at that to deal with
the complications of decompensated
cirrhosis.
Lifestyle - avoid aspirin & NSAIDs, avoid
alcohol, reduced salt intake.
Monitoring - 6-monthly USS & serum alphafetprotein to detect development of HCC.
Transplant as a last resort.

Complications:
Portal hypertension
Ascites
Portosystemic encephalopathy
Renal failure
HCC
Infection
Malnutrition